It is dinner time. An aged mother waits anxiously for her daughter to come and help her out of bed, remembering that once last week she didn't come for an hour. When her daughter appears in the doorway two hours later, the mother is wet, hungry and frightened. "Why didn't you come when I called?" she asks weakly. "Look, I was BUSY," comes the angry reply.
Neglect. Abuse. Call it what you may, this episode is a common type of abuse and an actuality in the lives of many of America's elderly population.
Different experts label abuse of the elderly "epidemic" and "a national tragedy." A number of bills now being considered in congressional subcommittees deal with its prevention and treatment.
In Maryland, accurate statistics about the extent of abuse are hard to come by because many cases go unreported and because Maryland police departments don't keep records of elder abuse. The Department of Social Services in Prince George's County investigated 18 reported cases of abuse--including neglect, exploitation and physical abuse--last month, compared with 10 in February and 9 in January. The large increase in March was in cases of physical mistreatment. Montgomery County investigates approximately 15 cases of all types each month. The majority of these suspected abuse reports are substantiated by social services investigative teams.
Who are the abused elders? According to expert testimony presented to Congress, they are for the most part females over 75 who are living with relatives, impaired mentally or physically, socially isolated and fearful of reprisal if they report an abuse or accept offers of assistance.
The abusers are usually middle-aged offspring who were abused themselves as children. They tend to be incapable of managing stress and are often alcoholic, drug-addicted or psychologically ill.
Corinne Stevens, director of Montgomery County's Adult Services, believes "any of us, put in the right circumstances, is a potential abuser. If we allow ourselves to be socially isolated, we could be driven to that."
Predictably, there are many theories about the root causes of elder abuse. Evidence gathered by experts indicates that the causes are multiple and complex. Abuse may result from stress inherent in the situation of an elder's entry into a home at a time when the adult children cannot afford the skyrocketing cost of medical care and other expenses.
Says Margaret Outen, supervisor of Adult Protective Services in Prince George's County: "The elder may arrive when the family can least afford the stress, and there is often a lack of understanding in the family on how to deal with the elder person."
Stevens is pleased that only 5 to 10 percent of the abuse reports investigated by her agency require court action. According to Maryland law, such involuntary intervention can occur only after the court has been convinced that attempts to gain voluntary access to the elder's premises have failed. She favors "the least restrictive alternative" for nonemergency cases.
Howard Segars, psychologist at Legal Research and Services for the Elderly Inc., who said he was abused as a child, proposes mediation by inter-disciplinary teams--"the kind of help which doesn't create its own set of dependencies."
The inter-disciplinary approach Segars describes characterizes the 8-year-old Assessment Center for Adults in Montgomery County. Its teams are made up of nurses, social workers, physicians and psychiatrists. The center, located at 5635 Fishers Lane in Rockville, is a joint effort of the county's Department of Health and the Department of Social Services. It began on the grassroots level as an experiment in preventing institutionalization of elderly persons. In 1977, center staff members were instrumental in the passage of Maryland's protective services law, according to a center report. The new law offered the center the mandate it was seeking--the legal power to provide protective services and treatment plans.
The 1977 law provides little help, however, for the prospective reporter of an abuse. Except for a Maryland nursing-home patient law, no other statutes exist that would require specified categories of persons to report abuses. Neither is there a law stipulating where and when reports should be filed and who should investigate.